title: Minimally invasive oesophagectomy more expensive than open despite shorter length of stay.
abstract: OBJECTIVE
  The minimally invasive oesophagectomy (MIO) approach offers a number of advantages over open approaches including reduced discomfort, shorter length of stay and a faster recovery to baseline status. On the other hand, minimally invasive procedures typically are longer and consume greater disposable instrumentation, potentially resulting in a greater overall cost. The objective of this study was to compare costs associated with various oesophagectomy approaches for oesophageal cancer.
  
  
  METHODS
  An institutional Resource Information Management System (RIMS) was queried for cost data relating to hospital expenditures (as opposed to billings or collections). The RIMS was searched for patients undergoing oesophagectomy for oesophageal cancer between 2003 and 2012 via minimally invasive, open transthoracic (OTT) (including Ivor Lewis, modified McKeown or thoracoabdominal) or transhiatal approaches. Patients that were converted from minimally invasive to open, or involved hybrid procedures, were excluded.
  
  
  RESULTS
  A total of 160 oesophagectomies were identified, including 61 minimally invasive, 35 open transthoracic and 64 transhiatal. Costs on the day of surgery averaged higher in the MIO group ($12 476 ± 2190) compared with the open groups, OTT ($8202 ± 2512, P < 0.0001) or OTH ($5809 ± 2575, P < 0.0001). The median costs associated with the entire hospitalization also appear to be higher in the MIO group ($25 935) compared with OTT ($24 440) and OTH ($15 248). The average length of stay was lowest in the MIO group (11 ± 9 days) compared with OTT (19 ± 18 days, P = 0.006) and OTH (18 ± 28 days P = 0.07). The operative mortality was similar in the three groups (MIO = 3%, OTT = 9% and OTH = 3%).
  
  
  CONCLUSIONS
  The operating theatre costs associated with minimally invasive oesophagectomy are significantly higher than OTT or OTH approaches. Unfortunately, a shorter hospital stay after MIO does not consistently offset higher surgical expense, as total hospital costs trend higher in the MIO patients. In an increasingly strained health care economy, efforts to reduce costs associated with the minimally invasive approach should address the inpatient hospitalization as well as operating theatre expenses.
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Anish
authors.initials: A
authors.lastname: Dhamija
authors.forename: Ankit
authors.initials: A
authors.lastname: Dhamija
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Hancock
authors.forename: Barbara
authors.initials: B
authors.lastname: McCloskey
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
mesh_terms: D000368:Aged; D016629:Esophagectomy / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: Cost analysis; Oesophageal cancer; Oesophageal surgery; Operations